Provider Demographics
NPI:1457302218
Name:HOUSTON COUNTY HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:HOUSTON COUNTY HEALTHCARE AUTHORITY
Other - Org Name:ADVANCED HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:334-712-3312
Mailing Address - Street 1:2253 THIRD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-5303
Mailing Address - Country:US
Mailing Address - Phone:334-712-3312
Mailing Address - Fax:334-712-3317
Practice Address - Street 1:2253 THIRD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-5303
Practice Address - Country:US
Practice Address - Phone:334-712-3312
Practice Address - Fax:334-712-3317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON COUNTY HEALTH CARE AUTHORITY DBA SOUTHEAST ALABAMA MEDICAL CEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0003112332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00521463-AMedicaid
AL000057683Medicaid
FL950246700Medicaid
AL51097062OtherBCBS AL
AL000057683Medicaid